保险索赔机会欺诈识别研究——基于汽车三责险人伤夸大索赔的样本  

Research on Identification of Opportunity Fraud in Insurance Claims——Sample Based on Exaggerated Claims for Bodily Injury in Automobile Third-party Liability Insurance

作　　者：周建涛[1] 张睿 周建波[2] Zhou Jiantao;Zhang Rui;Zhou Jianbo(School of Economics and Management,Beihang University,Beijing 100191,China;School of Economics,Peking University,Beijing 100871,China)

机构地区：[1]北京航空航天大学经济管理学院,北京100191 [2]北京大学经济学院,北京100871

出　　处：《河北经贸大学学报》2023年第3期89-101,共13页Journal of Hebei University of Economics and Business

基　　金：教育部规划基金项目“转型期防范索赔机会欺诈乱象研究”(18YJA790119);2021年北京航空航天大学教改项目“中华宽容美德融入经管《商法》生案例模拟法庭探索”。

摘　　要：汽车三责险人伤夸大索赔是一种广泛存在的机会欺诈,但被社会道德谴责的程度较轻,如果不加以遏制,将对社会产生不良诱导。理论上,基于时间成本、信息搜集成本、道德感等因素建立适合法院判决样本的机会欺诈模型,针对参数对夸大索赔的影响进行蒙特卡洛模拟。实证上,通过非参数统计和回归统计,分析肇事者事故责任比例、索赔人失业等影响夸大索赔因素的作用机制,使用决策树方法识别夸大索赔,发现对较严重、额度较大的机会欺诈进行预测效果更优。为此,保险公司应建立明确的赔付规定,减少信息不对称带来的不良影响,相关部门要注重凭据规范,使责任划分更加精细。The exaggerated claims for bodily injury in automobile third-party liability insurance is a widespread opportunity fraud,which is less condemned by social morality.If it is not curbed,it will produce adverse inducement to society.Theoretically,this paper establishes an opportunity fraud mode suitable for the court decision samples based on time cost,information collection cost,moral sense and other factors,and also conducts Monte Carlo simulation on the impact of the above parameters on exaggerated claims.Empirically,nonparametric statistics and regression statistics are used to analyze the mechanism of factors that affect exaggerated claims,such as the proportion of accident responsibility of the perpetrators and the unemployment of claimants.The decision tree method is used to identify exaggerated claims,and it is found that the prediction effect is better for more serious and large amount of opportunity fraud.To this end,insurance companies should establish clear compensation regulations and reduce the adverse effects caused by information asymmetry,relevant departments should pay attention to the standardization of credentials and make the division of responsibilities more detailed.

关 键 词：汽车三责险 保险索赔欺诈 法院判决金额 人伤夸大索赔 保险理赔额 

分 类 号：F842.6[经济管理—保险]